MEDICARE: CALEB JOHN RACKARD ALC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	ALC06040	AL

General Provider Information

NPI Number	:	1528991445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALEB JOHN RACKARD ALC

Provider Business Mailing Address
First Line	:	PO BOX 316
Second Line	:
City	:	COLLINSVILLE
State	:	AL
Zip	:	35961-0316
Country	:	US
Telephone Number	:	256-641-4007
Fax Number	:

Provider Business Practice Location Address
First Line	:	701B GAULT AVE N
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-2627
Country	:	US
Telephone Number	:	256-979-1620
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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